Provider Demographics
NPI:1639431521
Name:LEE, VANESSA RENEE (MS)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:RENEE
Last Name:LEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 JERUSALEM AVE UNIT 123
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3070
Mailing Address - Country:US
Mailing Address - Phone:516-884-6432
Mailing Address - Fax:
Practice Address - Street 1:1027 JERUSALEM AVE UNIT 123
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3070
Practice Address - Country:US
Practice Address - Phone:516-884-6432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist